Hepatitis Interactive Maps

How to use this tool

This map was created to visualize key conclusions for the publication “Hepatitis A epidemiology in Latin American countries: a systematic literature review”. The objective is to show the current state of hepatitis A endemicity in LATAM and its correlation to sociodemographic and sanitary conditions.

AMPI

HAV Age-seroprevalence

SDI

Water Index

Age at midpoint of population immunity (AMPI)

The age at midpoint of population immunity (AMPI) is the youngest age at which at least half of the population has serologic evidence of prior HAV infection. To estimate it, curve fitting models were used in countries with available age-specific seroprevalence data. Estimated endemicity levels were based on the estimated AMPIs:

We defined high endemicity as an AMPI <5 years of age, high-intermediate as 5–9 years, intermediate as 10–14 years, low-intermediate as 15–19 years, low as 20–29 years, and very low as ≥30 years of age

Socioeconomic variables (Gross National Income, water and sanitation access) were added and used to assign AMPI to countries without age-specific seroprevalence data (see the info box in the countries marked with an *).

Note: The following countries have implemented vaccination programs and are likely to shift to an older AMPI in the coming years. In this publication they have been classified as “low-intermediate”.

· Brazil

· Mexico

· Paraguay

· Colombia

Reference:

Mohd Hanafiah K, Jacobsen KH, Wiersma ST. Challenges to mapping the health risk of hepatitis A virus infection. Int J Health Geogr. 2011;10:57

HAV Age-seroprevalence layer

In this layer, the classification of age-seroprevalence of HAV in each country is based on the prevalence of anti-HAV antibodies in serologic samples taken from population-based studies.

High: ≥90% of the population have immunity by age 10

Intermediate: ≥50% of the population have immunity by age 15

Low: ≥50% of the population have immunity by age 30

Hover over each country to see it’s endemicity level and click on the information box for an outline of the seroprevalence studies used. Each reference has been summarized according to study design, region, time and outcome. In the comments column you can find additional information on the data collection methods. If you wish to view the publication, click on the reference for a direct link.

References

Jacobsen KH, Wiersma ST. Hepatitis A virus seroprevalence by age and world region, 1990 and 2005. Vaccine. 2010;28(41): 6653-7.

Publication link

SDI layer

The Institute for Health Metrics and Evaluation has developed an indicator of development status which is correlated with a health outcome. The dataset provided here shows the Socio-demographic Index values according to the estimated GBD 2017 locations. Seroprevalence rates of hepatitis A have been correlated with socioeconomic status as well as access to clean water and sanitation.

All countries in Latin America fall within the middle SDI range. Click on each country to see the exact SDI estimate for 2017.

References:

Global Burden of Disease 2017: Socio-demographic Index (SDI) 1950-2017. https://knoema.com/IHMESDI2018/gbd-2017-socio-demographic-index-sdi-1950-2017

Jacobsen K.H, Koopman J.S. Declining hepatitis A seroprevalence: a global review and analysis.
Epidemiol. Infect. (2004), 132, 1005–1022.
https://www.researchgate.net/publication/8095254...

Access to water

Hepatitis A is transmitted through the fecal-oral route, through close contact with infected persons and through contaminated food or water. Increasing access to clean water, sanitation and hygiene is directly correlated with a decrease in hepatitis A prevalence.

This dataset provides an estimate for the indicator “Risk-weighted prevalence of populations using unsafe or unimproved water sources, as measured by the summary exposure value (SEV) for unsafe water (%)” from 2017. For this indicator, a “universal water access” is considered achieved if the estimate is greater than or equal to 99%.

Click on each country to see the percentage of the population with access to safe water sources.

References:

Jacobsen K.H, Koopman J.S. Declining hepatitis A seroprevalence: a global review and analysis.
Epidemiol. Infect. (2004), 132, 1005–1022. https://www.researchgate.net/publication/8095254...

Global Burden of Disease Study 2017 (GBD 2017). Health-related Sustainable Development Goals (SDG) Indicators 1990-2030. http://ghdx.healthdata.org/record/ihme-data/gbd-2017-health-related-sdgs-1990-2030

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Reference	Design	Outcome description	Region and study period	Outcomes stratified by age	Outcome			Quality score and comment
Reference	Design	Outcome description	Region and study period	Outcomes stratified by age	n/N	Outcome	95% CI	Quality score and comment
Vizzotti, 2014 (9)	Surveillance study	Mean incidence rate per 100,000 inhabitants pre-and post-vaccination	Nationwide Jan 2000-Dec 2011	All ages	NR	Pre: 66.5 Post: 7.9	NR	Case detection: Strong Data collection methods: Moderate Prevaccination = 2000-2002 Postvaccination = 2006-2011 Outbreak data (2003-2004) and year of introduction vaccine (2005) were excluded from analysis.
				0-4 year	NR	Pre: 162.2 Post: 15.5	NR
				5-9 year	NR	Pre: 245.2 Post: 26.6	NR
				10-14 year	NR	Pre: 111.5 Post: 14.9	NR
				15-44 year	NR	Pre: 15.5 Post: 4.2	NR
				>45 year	NR	Pre: 5.3 Post: 2.2	NR
Vizzotti, 2014 (20)	Cross-sectional study	Seroprevalence (N; %)	Buenos Aires city and province, Tucumán location and Santa Fe city March-Nov 2011	12 months (before vaccination)	128/433	29.6	25.2-33.8	Case detection: Moderate Data collection methods: Strong Limitation mentioned by the authors of the article: the period of time for wild virus circulation exposure in the group of unvaccinated infants was not so long considering the half-life of maternal antibodies.
Vizzotti, 2014 (20)	Cross-sectional study	Seroprevalence (N; %)		65 months (after vaccination)	1059/1139	93	91.7-94.6
Yanez, 2013 (19)	Retrospective study	Seroprevalence (N; %)	Córdoba Sept 2009-Sept 2010	≥15 year	306/416	73.5	NR	Case detection: Moderate Data collection methods: Strong Participants were only eligible for this study if they were not vaccinated against HAV.
				15-25 year	50/94	53.2	NR
				26-35 year	64/108	59.2	NR
				36-45 year	54/70	77.1	NR
				46-55 year	64/69	92.7	NR
				>56 year	74/75	98.7	NR

Reference	Design	Outcome description	Region and study period	Outcomes stratified by age	Outcome			Quality score and comment
Reference	Design	Outcome description	Region and study period	Outcomes stratified by age	n/N	Outcome	95% CI	Quality score and comment
Campolmi, 2018 (21)	Cross-sectional study	Seroprevalence (N; %)	Chaco Nov 2013	≥1 year	232/244	95.1	92.4-97.8	Case detection: Moderate Data collection methods: Strong
				1-5 year	7/14	50	NR
				6-10 year	27/31	87.1	NR
				11-20 year	55/55	100	NR
				21-30 year	33/33	100	NR
				31-40 year	37/37	100	NR
				41-50 year	23/23	100	NR
				51-60 year	17/17	100	NR
				≥61 year	33/34	97.1	NR
Masuet-Aumatell, 2013 (22)	Cross-sectional study	Seroprevalence (N; %)	Cochabamba region March-April 2010	5-16 year	NR/436	95.4	93.3-97.4	Case detection: Moderate Data collection methods: Strong
				5,1-10,0 year	96/99	97	93.6-100
				10.1-13.0 year	228/233	97.9	96.0-99.7
				>13.0 year	97/104	93.3	88.5-98.1
Gandolfo, 2003 (23)	Cross-sectional study	Seroprevalence (N; %)	Santa Cruz de la Sierra Period NR	6-18 year	781/952	82	78-87	Case detection: Moderate Data collection methods: Strong
				6-8 year	NR	76.6	NR
				9-12 year	NR	78.1	NR
				13-18 year	NR	84.1	NR

Reference	Design	Outcome description	Region and study period	Outcomes stratified by age	Outcome			Quality score and comment
Reference	Design	Outcome description	Region and study period	Outcomes stratified by age	n/N	Outcome	95% CI	Quality score and comment
Ciaccia, 2012 (24)	Cross-sectional study	Seroprevalence (N; %)	Santos 2007	7 months – 18 year	413/4249	9.7	NR	Case detection: Moderate Data collection methods: Strong
				Day-care	21/835	2.5	NR
				Kindergarten	65/1188	5.5	NR
				Elementary 1st-4th	192/1263	15.2	NR
				Elementary 5th-8th	135/963	14	NR
Gomes, 2011 (25)	Cross-sectional study	Seroprevalence (N; %)	São Luis 2003	7-14 year	NR/462	64	60-68	Case detection: Moderate Data collection methods: Strong
				7-8 year	39/78	50	NR
				9-10 year	57/106	54	NR
				11-12 year	97/138	70	NR
				13-14 year	102/140	73	NR
Krebs, 2011 (26)	Cross-sectional study	Seroprevalence (N; %)	Porto Alere April 2007- Jan 2008	Gr 1: 1-19 yr	91/222	37.6	NR	Case detection: Moderate Data collection methods: Strong Gr 1 = Group 1 - Public laboratory (low socioeconomic status) Gr 2 = Group 2 - Private laboratory (higher socioeconomic status)
				Gr 1: 1-4 yr	7/36	19.4	NR
				Gr 1: 5-9 yr	8/31	25.8	NR
				Gr 1: 10-14 yr	30/70	42.9	NR
				Gr 1: 15-19 yr	46/85	54.1	NR
				Gr 2: 1-19 yr	107/243	46.1	NR
				Gr 2: 1-4 yr	16/32	50	NR
				Gr 2: 5-9 yr	19/34	55.9	NR
				Gr 2: 10-14 yr	47/91	51.7	NR
				Gr 2: 15-19 yr	25/86	29.1	NR
Kury, 2016 (27)	Cross-sectional study	Seroprevalence (N; %)	Campos dos Goytacazes Aug 2011- July 2012	1-19 year	NR/919	20.7	NR	Case detection: Moderate Data collection methods: Strong
				1-4 year	7/132	5.3	NR
				5-9 year	81/433	18.7	NR
				10-14 year	89/315	28.3	NR
				15-19 year	13/39	33.3	NR
Mantovani, 2015 (28)	Cross-sectional study	Seroprevalence (N; %)	Assis Brasil, state of Acre 2011	1-5 year	NR/312	16.66	NR	Case detection: Moderate Data collection methods: Strong It is possible that the prevalence of children with detectable antibodies against HAV was slightly overestimated because untested children were younger and living under more favourable conditions.
				12-23 months	NR/71	11.26	NR
				24-35 months	NR/82	14.63	NR
				35-48 months	NR/72	13.88	NR
				48-59 months	NR/87	24.13	NR
Markus, 2011 (29)	Cross-sectional study	Seroprevalence (N; %)	Curitiba, Paraná Feb-Aug 2006	1-4 year	7/237	3	NR	Case detection: Moderate Data collection methods: Strong
				5-9 year	66/313	21.1	NR
				10-14 year	105/351	14	NR
Nunes, 2016 (30)	Cross-sectional study	Seroprevalence (N; %)	West Region of the Pará State (Juruti municipality) Feb 2007- Nov 2010	All ages	3452/4003	86.2	NR	Case detection: Moderate Data collection methods: Strong
				˂1 year	4/10	40	NR
				1-4 year	108/317	34.1	NR
				5-9 year	347/489	71	NR
				10-19 year	623/728	85.6	NR
				20-29 year	787/823	94.5	NR
				30-39 year	610/621	98.2	NR
				40-49 year	384/395	97.5	NR
				50-59 year	323/334	96.7	NR
				˃60 year	265/376	96.9	NR
Nunes, 2017 (31)	Cross-sectional study	Seroprevalence (N; %)	Parauapebas Microregion - Canaa dos Carajas Aug 2012-Sept 2014	All ages	630/825	76.4	NR	Case detection: Moderate Data collection methods: Strong
				˂1 year	0/1	-	NR
				1-4 year	11/48	22.9	NR
				5-9 year	32/89	36	NR
				10-19 year	130/201	64.7	NR
				20-29 year	107/119	89.9	NR
				30-39 year	111/119	93.3	NR
				40-49 year	103/106	97.2	NR
				50-59 year	67/69	97.1	NR
				˃60 year	69/72	95.8	NR
			Parauapebas Microregion – Curionópolis 16-29 of January 2013	All ages	319/376	84.8	NR
				˂1 year	1/1	100	NR
				1-4 year	10/23	43.5	NR
				5-9 year	10/23	43.5	NR
				10-19 year	64/85	75.3	NR
				20-29 year	29/33	87.9	NR
				30-39 year	36/37	97.3	NR
				40-49 year	33/35	94.3	NR
				50-59 year	56/57	98.2	NR
				˃60 year	80/82	97.6	NR
Perazzo, 2017 (36)	Surveillance study	Age-standardised mortality rates per 100,000 inhabitants	Brazilian states and legally valid subnational units as North, Northeast, Central-West, Southeast and South regions, respectively. 2008-2014	North Brazil	NR	0.066	0.049-0.087	Mortality rates apply to the total study period of 7 years. This study was not assessed with the quality assessment tool because the outcomes studied were not eligible to assess with this tool (e.g. mortality rates: The Brazilian National Death Registry was analysed from 2008 to 2014 and viral hepatitis deaths were defined by ICD-10 codes.)
				Northeast Brazil	NR	0.039	0.036-0.046
				Southeast Brazil	NR	0.024	0.020-0.028
				South Brazil	NR	0.023	0.017-0.031
				Central-West Brazil	NR	0.035	0.024-0.050
				Brazil, total	NR	0.032	0.029-0.035
Pereira, 2016 (32)	Cross-sectional study	Seroprevalence (N; %)	Assis Brasil, state of Acre 2003	1-5 year	39/147	26.5	19.4-33.7	Case detection: Moderate Data collection methods: Strong
				12-23 months	NR/40	12,5	NR
				24-35 months	NR/37	18,9	NR
				35-48 months	NR/38	34,2	NR
				48-59 months	NR/32	43,8	NR
			Assis Brasil, state of Acre 2010	1-5 year	57/254	22.4	17.3-27.6
				12-23 months	NR/60	5	NR
				24-35 months	NR/52	11.5	NR
				35-48 months	NR/76	26.3	NR
				48-59 months	NR/66	42.4	NR
Pinheiro, 2015 (33)	Cross-sectional study	Seroprevalence (N; %)	Southwest Goiás, Central Brazil May-July 2011	2-93 year	NR/466	82.2	78.5-85.5	Case detection: Moderate Data collection methods: Strong Because of unknown reasons the total N for the different age strata does not add up to total N study (N=466).
				5-9 year	6/40	15	7.1-29.1
				10-19 year	40/68	58.8	47-69.7
				>20 year	337/343	98.2	NR
Souto, 2019 (37)	Surveillance study	Incidence rate per 100,000 inhabitants	Nationwide 2010	All ages	6424/ 195497797	3.29	NR	Case detection: Strong Data collection methods: Strong Objective: Analysing time series of HAV cases reported to the Brazilian National Epidemiologic Surveillance System (SINAN) over the current decade (2010–2017) to assess the impact of vaccination on the incidence of the disease in the early years after the start of the program (2015–2017). The data on hepatitis A mortality for 2017 were preliminary. See evidence table in Excel (appendix V) for age specific incidence rates for all years, we here included only the age specific incidence rates of 2017.
			Nationwide 2011	All ages	6876/ 197397018	3.48	NR
			Nationwide 2012	All ages	6009/ 199242462	3.02	NR
			Nationwide 2013	All ages	6194/ 201032714	3.08	NR
			Nationwide 2014	All ages	6655/ 202768562	3.28	NR
			Nationwide 2015	All ages	2984/ 204450649	1.46	NR
			Nationwide 2016	All ages	964/ 206081432	0.47	NR
			Nationwide 2017	All ages	1502/ 207660929	0.72	NR
				<5 year	31/14360778	0.22	NR
				5-14 year	116/31777888	0.37	NR
				15-19 year	104/17150098	0.61	NR
				20-39 year	892/68254915	1.31	NR
				40-59 year	257/50152631	0.51	NR
				≥60 year	102/25964619	0.39	NR
Vitral, 2014 (34)	Cross-sectional study	Seroprevalence (N; %)	Pedro Peixoto settlement March-April 2004 Sept-Oct 2004	5-90 year	329/397	82.9	79,2-86,6	Case detection: Moderate Data collection methods: Strong
				5-10 year	NR/69	46.4	NR
				11-20 year	NR/111	80.2	NR
				21-30 year	NR/67	95.5	NR
				31-50 year	NR/103	97.1	NR
				>50 year	NR/47	93.6	NR
Vitral, 2012 (35)	Cross-sectional study	Seroprevalence (N; %)	Rio de Janeiro April 2007-July 2009	1-18 year	277/686	40.4	NR	Case detection: Moderate Data collection methods: Strong Stratified results were not always shown for all regions
				1-4 year	18/180	10	NR
				5-9 year	134/287	46.7	NR
				10-14 year	94/165	57	NR
				15-18 year	31/54	57.4	NR
			Cuiabá April 2007-July 2009	1-18 year	128/322	39.8	NR
				1-4 year	NR	13.2	NR
				5-9 year	NR	29.3	NR
				10-14 year	NR	53.8	NR
				15-18 year	NR	68.9	NR
			Manaus April 2007-July 2009	1-18 year	76/155	49	NR
				1-4 year	NR	25.9	NR
				5-9 year	NR	39.5	NR
				10-14 year	NR	74.5	NR
				15-18 year	NR	80	NR

Reference	Design	Outcome description	Region and study period	Outcomes stratified by age	Outcome			Quality score and comment
Reference	Design	Outcome description	Region and study period	Outcomes stratified by age	n/N	Outcome	95% CI	Quality score and comment
Taylor, 2001 (44)	Cross-sectional study	Seroprevalence (N; %)	Nationwide 1996	<7 year	NR/873	6.8	NR	Case detection: Strong/Moderate Data collection methods: Strong Students and employees of the UCR do not add up to the total UCR adult population. Footnote table 5: Only information of 713 people was obtained. However, table 2 shows a total of 996 persons.
			Nationwide 1996/1997	9-15 year	NR/614	13.2	NR
				9-11 year	NR/355	9.3	NR
				12-15 year	NR/259	18.5	NR
			Nationwide 1994	Adults UCR	NR/996	71.7	NR
				<30 year, students	195/399	49	NR
				>30 year, students	41/43	95	NR
				<30 year, employees	46/65	71	NR
				>30 year, employees	184/206	89	NR
Ministerio de Salud – GL (45)	Epidemiological report	Incidence rate per 100,000 inhabitants	Nationwide 2009	All ages	144/NR	3.19	NR	Preliminary data for 2013: 561 cases, 11.94 incidence rate/100,000 inhabitants.
			Nationwide 2010	All ages	66/NR	1.45	NR
			Nationwide 2011	All ages	113/NR	2.45	NR
			Nationwide 2012	All ages	368/NR	7.91	NR
UCR = University of Costa Rica; GL = Grey Literature

Reference	Design	Outcome description	Region and study period	Outcomes stratified by age	Outcome			Quality score and comment
Reference	Design	Outcome description	Region and study period	Outcomes stratified by age	n/N	Outcome	95% CI	Quality score and comment
Miranda, 2018 (38)	Cross-sectional study	Seroprevalence (N; %)	Metropolitan area of Santiago 2004-2006	≥2 year	399/498	80.1	NR	Case detection: Moderate Data collection methods: Strong
				2-9 year	7/19	36.8	NR
				10-19 year	24/62	38.7	NR
				20-29 year	52/87	59.8	NR
				30-39 year	75/83	90.4	NR
				40-49 year	75/80	93.8	NR
				50-59 year	89/90	98.9	NR
				60-69 year	60/60	100	NR
				>70 year	17/17	100	NR
			Metropolitan area of Santiago 2014-2016	≥2 year	348/516	67.4	NR
				2-9 year	3/14	21.4	NR
				10-19 year	15/53	28.3	NR
				20-29 year	31/97	32	NR
				30-39 year	56/91	61.5	NR
				40-49 year	70/81	86.4	NR
				50-59 year	78/84	92.9	NR
				60-69 year	68/69	98.6	NR
				>70 year	27/27	100	NR
Fix, 2002 (39)	Cross-sectional study	Seroprevalence (N; %)	Santiago 1998	1-24 year	NR/784	32.4	29.2-35.8	Case detection: Moderate Data collection methods: Strong
				1-4 year	NR/367	12.5	9.4-16.5
				5-9 year	NR/107	26.2	18.4-35.8
				10-14 year	NR/106	43.4	33.7-53.6
				15-19 year	NR/101	57.4	47.3-67.0
				20-24 year	NR/103	73.9	64.4-81.7
Tanaka, 2000 (18)	Cross-sectional study	Seroprevalence (N; %)	Santiago Period NR	1-40 year	NR/496	58.1	NR	Case detection: Can't tell Data collection methods: Strong
				1-5 year	NR	11	NR
				6-10 year	NR	31	NR
				11-15 year	NR	71.1	NR
				16-20 year	NR	79.4	NR
				21-30 year	NR	96.5	NR
				31-40 year	NR	100	NR
Ministerio de Salud, 2018 – GL (40)	Epidemiological report	Incidence rate per 100,000 inhabitants	Nationwide 1 Jan up until 29 Sept 2018	All ages	NR	11.6	NR	Incidence rates apply to the first 39 weeks of 2018.
				0-4 year	NR	5.2	NR
				5-9 year	NR	19	NR
				10-14 year	NR	17.5	NR
				15-19 year	NR	26.2	NR
				20-24 year	NR	29.9	NR
				25-29 year	NR	26	NR
				30-34 year	NR	15	NR
				35-39 year	NR	8.5	NR
				40-44 year	NR	4.4	NR
				45-49 year	NR	3	NR
				50-54 year	NR	1.8	NR
				55-59 year	NR	1.6	NR
				60-64 year	NR	1.1	NR
				≥65 year	NR	1.1	NR

Reference	Design	Outcome description	Region and study period	Outcomes stratified by age	Outcome			Quality score and comment
Reference	Design	Outcome description	Region and study period	Outcomes stratified by age	n/N	Outcome	95% CI	Quality score and comment
Rubio, 2006 (41)	Cross-sectional study	Seroprevalence (N; %)	Bogotá Period NR	1-39 year	NR/893	69.5	66.5-72.6	Case detection: Moderate Data collection methods: Can't tell
				1-4 year	NR/90	27.8	18.5-37.0
				5-9 year	NR/108	47.2	37.8-56.6
				10-14 year	NR/97	62.9	53.3-72.5
				15-19 year	NR/168	69	62.1-76.0
				20-29 year	NR/267	82	77.4-86.6
				30-39 year	NR/163	91.4	87.1-95.7
Vega, 2003 (42)	Cross-sectional study	Seroprevalence (N; %)	Medellín 1997	2-40 year	74/306	24.2	19.4-29.0	Case detection: Moderate Data collection methods: Strong
Instituto Nacional de Salud, 2019 – GL (43)	Epidemiological report	Incidence rate per 100,000 inhabitants	Nationwide First 7 weeks of 2019	All ages	NR	0.8	NR	Incidence rates apply to the first 7 weeks of 2019.
				<1 year	NR	0.113	NR
				1-4 year	NR	0.287	NR
				5-9 year	NR	1.026	NR
				10-14 year	NR	1.881	NR
				15-19 year	NR	1.571	NR
				20-24 year	NR	1.446	NR
				25-29 year	NR	0.884	NR
				30-34 year	NR	0.863	NR
				35-39 year	NR	0.788	NR
				40-44 year	NR	0.872	NR
				45-49 year	NR	0.177	NR
				50-54 year	NR	0.354	NR
				55-59 year	NR	0.118	NR
				≥60 year	NR	0.1	NR

Reference	Design	Outcome description	Region and study period	Outcomes stratified by age	Outcome			Quality score and comment
Reference	Design	Outcome description	Region and study period	Outcomes stratified by age	n/N	Outcome	95% CI	Quality score and comment
Berdasquera Corcho, 2006 (47)	Retrospective descriptive study	Incidence rate per 10,000 inhabitants	Guanajay 2000	All ages	34/NR	11.64	NR	Case detection: Moderate Data collection methods: Can't tell
			Guanajay 2001	All ages	130/NR	44.54	NR
			Guanajay 2002	All ages	14/NR	4.79	NR
			Guanajay 2003	All ages	10/NR	3.42	NR
			Guanajay 2004	All ages	32/NR	10.96	NR
			Guanajay 2005	All ages	199/NR	68.18	NR
Blanco Hernández, 2009 (48)	Retrospective descriptive study	Incidence rate per 1,000 inhabitants	Boyeros 2000	All ages	NR	1.8	NR	Case detection: Moderate Data collection methods: Can't tell Total study period comprised the years 1989-2006 (see evidence tables in Excel, appendix V). We here only showed the most recent years. Additionally, data extracted in the Excel document shows the incidence rate over 18 years, stratified for age.
			Boyeros 2001	All ages	NR	1.5	NR
			Boyeros 2002	All ages	NR	3.6	NR
			Boyeros 2003	All ages	NR	0.6	NR
			Boyeros 2004	All ages	NR	0.8	NR
			Boyeros 2005	All ages	NR	4.1	NR
			Boyeros 2006	All ages	NR	3.8	NR
Quintana, 2005 (46)	Cross-sectional study	Seroprevalence	‘‘La Lisa’’ district of Havana Period NR	5-55 year	149/209	71.3	NR	Case detection: Moderate Data collection methods: Strong
Aguiar, 2004 – GL (49)	Surveillance report	Incidence rate per 100,000 inhabitants	Nationwide 1992-2002	< 1 year	NR	12.58	NR	Incidence rates apply to the total study period of 11 year. Before 2002, HAV diagnosis in Cuba was based on exclusion, meaning all cases who were negative for HBV and HCV. Therefore the incidence rate might not be reliable before this period.
				1-4 year	NR	238.61	NR
				5-9 year	NR	292.33	NR
				10-14 year	NR	326.74	NR
				15-24 year	NR	138.55	NR
				25-59 year	NR	61.88	NR
				60-64 year	NR	26.39	NR
				≥ 65 year	NR	11.74	NR

Reference	Design	Outcome description	Region and study period	Outcomes stratified by age	Outcome			Quality score and comment
					n/N	Outcome	95% CI
Tanaka, 2000 (18)	Cross-sectional study	Seroprevalence (N; %)	Santo Domingo Period NR	1-5 year	NR	63	NR	Case detection: Can't tell Data collection methods: Strong
				6-10 year	NR	82	NR
				11-15 year	NR	91	NR
				16-20 year	NR	98.5	NR
				21-30 year	NR	97	NR
				31-40 year	NR	98	NR

Reference

Design

Outcome description

Region and

study period

Outcomes stratified by age

Outcome

Quality score and comment

n/N

Outcome

95% CI

Ministerio de Salud 2019 – GL (56)

Epidemiological report

Incidence rate per 100,000 inhabitants

Nationwide

First 14 weeks of 2019

All ages

261/6192824

4.21

Incidence rates apply to the first 14 weeks of 2019.

Data must be interpreted with caution. It might be that the incidence rates are slightly lower or higher than our estimates.

Reference	Design	Outcome description	Region and study period	Outcomes stratified by age	Outcome			Quality score and comment
Reference	Design	Outcome description	Region and study period	Outcomes stratified by age	n/N	Outcome	95% CI	Quality score and comment
Torres, 2016 (50)	Cross-sectional study	Seroprevalence (N; %)	Quito Period NR	5-15 year	124/399	31.08	NR	Case detection: Moderate Data collection methods: Strong
Ministerio de Salud Publica, 2018 – GL (55)	Epidemiological report	Incidence rate per 100,000 inhabitants	Nationwide 2018	All ages	4046/16983153	23.82	NR	–
NR, thesis – GL (51)	Cross-sectional study	Seroprevalence (N; %)	Riobamba, Academic year 2009-2010	16-18 year	68/150	45.33	NR	–
Alexandra, thesis – GL (52)	Cross-sectional study	Seroprevalence (N; %)	Cayambe 2014	≤15 year	23/166	13.86	NR	–
				7 year	NR/4	0.6	NR
				8 year	NR/11	2.41	NR
				9 year	NR/4	0	NR
				10 year	NR/18	1.2	NR
				11 year	NR/9	0	NR
				12 year	NR/19	2.41	NR
				13 year	NR/60	4.82	NR
				14 year	NR/36	1.2	NR
				15 year	NR/5	1.81	NR
Guamán Zhunio, thesis – GL (53)	Cross-sectional study	Seroprevalence (N; %)	Huaquillas Nov 2011-Jan 2012	NR - 7th year educación básica	17/63	26.98	NR	–
Chamba-Salinas, thesis – GL (54)	Cross-sectional study	Seroprevalence (N; %)	Nambacola Nov 2013-Jul 2014	8-10 year	15/102	14.7	NR	–

Reference	Design	Outcome description	Region and study period	Outcomes stratified by age	Outcome			Quality score and comment
					n/N	Outcome	95% CI
Steinberg, 2004 (57)	Cross-sectional study	Seroprevalence (N; %)	San Juan Sacatepéquez Sept 30-Dec 1, 1999	6-36 months	256/NR	48.8	NR	Case detection: Moderate Data collection methods: Strong
				6-12 months	NR	40	NR
				13-18 months	NR	28	NR
				19-24 months	NR	46	NR
				25-30 months	NR	60	NR
				31-36 months	NR	76	NR
Ministerio de Salud, 2019 – GL (58)	Epidemiological report	Incidence rate per 100,000 inhabitants	Nationwide 2018 week 1-11	All ages	388/NR	2.24	NR	Incidence rates apply to the first 11 weeks of 2018/2019. The report shows that the amount of cases of HAV in the first 11 weeks of 2019 is exceptionally high compared to previous years, which might indicate an outbreak.
			Nationwide 2019 week 1-11	All ages	903/NR	5.22	NR

Reference	Design	Outcome description	Region and study period	Outcomes stratified by age	Outcome			Quality score and comment
					n/N	Outcome	95% CI
Dirección de Vigilancia Epidemiologica, 2019 – GL (59)	Epidemiological report	Incidence rate per 100,000 inhabitants	Nationwide First 14 weeks of 2018	All ages	756/NR	8.5	NR	Incidence rates apply to the first 14 weeks of 2018/2019.
			Nationwide First 14 weeks of 2019	All ages	786/NR	8.84	NR

Reference	Design	Outcome description	Region and study period	Outcomes stratified by age	Outcome			Quality score and comment
					n/N	Outcome	95% CI
Lazcano-Ponce, 2013 (60)	Cross-sectional study	Seroprevalence (N; %)	Central, Mexico city, Southern and Northern Mexico Jan-Oct 2010	1-95 year	NR/3984	84,2	81,7-86,7	Case detection: Strong Data collection methods: Strong
				1-9 year	NR	45	39,4-50,5
				10-19 year	NR	80,1	76,7-83,6
				≥20 year	NR	96,9	93,9-99,8
Lopez-Gatell, 2018 (61)	Cross-sectional study	Seroprevalence (N; %)	Mexico City, Centre, North and South Oct 2011-Oct 2012	10-25 year	NR	69,3	64,8-73,4	Case detection: Strong Data collection methods: Strong The Excel document (appendix V) additionally shows other combinations of age categories.
				10-14 year	NR	56	48,7-63
				15-19 year	NR	61,6	53,2-69,4
				20-25 year	NR	83	75,3-89

Reference	Design	Outcome description	Region and study period	Outcomes stratified by age	Outcome			Quality score and comment
Reference	Design	Outcome description	Region and study period	Outcomes stratified by age	n/N	Outcome	95% CI	Quality score and comment
Mayorga Perez, 2014 (62)	Cross-sectional study	Seroprevalence (N; %)	León, 1995/96	1,5-<7 years	NR/974	67	NR	Case detection: Moderate Data collection methods: Strong
				18-23 months	48/126	38,1	NR
				24-29 months	58/113	51,3	NR
				30-35 months	83/145	57,3	NR
				36-47 months	170/232	73,3	NR
				48-59 months	150/189	79,4	NR
				60-71 months	148/169	87,6	NR
			León 2003	1,5-<7 years	NR/195	42	NR
				6-11 months	14/30	46.7	NR
				12-17 months	4/34	11.8	NR
				18-23 months	3/28	10.7	NR
				24-29 months	7/29	24.1	NR
				30-35 months	12/35	34.3	NR
				36-47 months	15/33	45.5	NR
				48-59 months	23/38	60.5	NR
				60-71 months	20/32	62.5	NR
				7-11 years	32/37	86.5	NR
				12-16 years	32/34	94.1	NR
				18-25 years	56/56	100	NR
				26-33 years	56/56	100	NR
				34-40 years	53/53	100	NR
Organización Panamericana de la Salud, NR – GL (63)	Epidemiological report	Incidence rate per 10,000 inhabitants	Nationwide 2005	All ages	1088/NR	2.12	NR
			Nationwide 2006	All ages	977/NR	1.9	NR
			Nationwide 2007	All ages	1535/NR	2.99	NR
			Nationwide 2008	All ages	1543/NR	3	NR
			Nationwide 2009	All ages	910/NR	1.77	NR
			Nationwide 2010	All ages	972/NR	1.89	NR
			Nationwide 2011	All ages	1422/NR	2.72	NR
			Nationwide 2012	All ages	1899/NR	3.69	NR

Reference	Design	Outcome description	Region and study period	Outcomes stratified by age	Outcome			Quality score and comment
Reference	Design	Outcome description	Region and study period	Outcomes stratified by age	n/N	Outcome	95% CI	Quality score and comment
Estripeaut, 2015 (65)	Passive surveillance system	Mean number of cases and % decline	West region 2000-2006 (prevaccination)	All ages	332/NR	74%	NR	Case detection: Strong Data collection methods: Strong Numbers in this evidence table include both hepatitis A cases and unspecified hepatitis cases, unless specified. The evidence table in the Excel document (appendix V) additionally includes age stratified incidence rates for the years 2000-2009. We included the most recent data of 2010 in the summary table.
			West region 2008-2010 (postvaccination)	All ages	85.3/NR
			Central region 2000-2006 (prevaccination)	All ages	120.9/NR	79%	NR
			Central region 2008-2010 (postvaccination)	All ages	25/NR
			Panama region 2000-2006 (prevaccination)	All ages	994.7/NR	85%	NR
			Panama region 2008-2010 (postvaccination)	All ages	146.7/NR
			Northeast region 2000-2006 (prevaccination)	All ages	117.1/NR	78%	NR
			Northeast region 2008-2010 (postvaccination)	All ages	25.3/NR
		Incidence rate per 100,000 inhabitants	Nationwide 2010	All ages	NR	3.7	NR
				<1 year	NR	0	NR
				1-4 year	NR	3.2	NR
				5-9 year	NR	2.6	NR
				10-14 year	NR	3.6	NR
				15-19 year	NR	6.2	NR
				20-24 year	NR	6	NR
				25-49 year	NR	3	NR
				≥50 year	NR	4.1	NR
Ministerio de Salud, 2016 – GL (64)	Epidemiological report	Incidence rate per 100,000 inhabitants	Nationwide 2015	All ages	18/NR	0.45	NR
Ministerio de Salud, 2016 – GL (64)	Epidemiological report	Incidence rate per 100,000 inhabitants	Nationwide 2016	All ages	33/NR	0.82	NR

Reference	Design	Outcome description	Region and study period	Outcomes stratified by age	Outcome			Quality score and comment
Reference	Design	Outcome description	Region and study period	Outcomes stratified by age	n/N	Outcome	95% CI	Quality score and comment
Multiple organisations, 2018 – GL (66)	Epidemiological report	Incidence rate per 100,000 inhabitants	Nationwide 2008	All ages	33/NR	0.53	NR	No population data for the specific years found on the websites of the government. Incidence rate per 100,000 was only presented for the years 2008-2010, not for 2011-2013.
			Nationwide 2009	All ages	115/NR	1.85	NR
			Nationwide 2010	All ages	27/NR	0.42	NR
			Nationwide 2011	All ages	5/NR	NR	NR
			Nationwide 2012	All ages	38/NR	NR	NR
			Nationwide 2013	All ages	4/NR	NR	NR

Reference	Design	Outcome description	Region and study period	Outcomes stratified by age	Outcome			Quality score and comment
Reference	Design	Outcome description	Region and study period	Outcomes stratified by age	n/N	Outcome	95% CI	Quality score and comment
Hernandez, 2015 (67)	Cross-sectional study	Seroprevalence (N; %)	Arequipa, Cajamarca, Iquitos, Lima and Piura 2010-2013	1-15 year	NR/1721	50.5	48.1-52.9	Case detection: Strong/moderate Data collection methods: Strong
				1 year	NR	20.7	NR
				2-4 year	NR	48.9	NR
				5-9 year	NR	55.2	NR
				10-15 year	NR	66.1	NR
Heriberto Hidalgo, 2002 (68)	Cross-sectional study	Seroprevalence (N; %)	Huánuco district April-Dec 2000	4-17 year	257/270	95.2	NR	Case detection: Moderate Data collection methods: Strong
				4-11 year	71/82	86.6	NR
				12-17 year	186/188	98.9	NR
Vildósola, 2000 (69)	Cross-sectional study	Seroprevalence (N; %)	Lima metropolitan 1999	1-39 year	560/859	65.2	NR	Case detection: Moderate Data collection methods: Strong
				1-4 year	25/88	28.4	NR
				5-9 year	57/133	42.9	NR
				10-14 year	81/131	61.8	NR
				15-19 year	109/166	65.7	NR
				20-29 year	129/172	75	NR
				30-39 year	159/169	94.1	NR

Reference	Design	Outcome description	Region and study period	Outcomes stratified by age	Outcome			Quality score and comment
Reference	Design	Outcome description	Region and study period	Outcomes stratified by age	n/N	Outcome	95% CI	Quality score and comment
Romero, 2012 (72)	Surveillance study	Incidence rate per 100,000 inhabitants	Nationwide 2005	All ages	2877/NR	88.7	85.5-92.0	Case detection: Strong Data collection methods: Can't tell Data in this evidence table for the years 2005-2007 shows outbreak data. From 2008 onwards a universal mandatory vaccination program started. The evidence table in the Excel document (appendix V) additionally shows data on incidence in the department of Artigas and the city of Bella Unión (selected because of the highest HAV incidence during 2005-2010).
			Nationwide 2006	All ages	1769/NR	54.6	52.0-57.1
			Nationwide 2007	All ages	527/NR	16.3	14.8-17.6
			Nationwide 2008	All ages	340/NR	10.5	8.3-10.4
			Nationwide 2009	All ages	255/NR	6.97	6.9-8.8
			Nationwide 2010	All ages	90/NR	2.7	2.2-3.3
Montano Lotito, 2001 (70)	Cross-sectional study	Seroprevalence (N; %)	Montevideo Dec 1997-June 1998	2-6 year	64/386	16.5	NR	Case detection: Moderate Data collection methods: Strong
				7-11 year	117/394	29.6	NR
				12-14 year	83/209	39.2	NR
				18-49 year	730/1198	61.4	NR
				18-27 year	207/400	51.8	NR
				28-37 year	249/394	63.8	NR
				38-49 year	274/404	68.3	NR
Quian, 2005 (71)	Cross-sectional study	Seroprevalence (N; %)	Montevideo Jan-May 2000	1-40 year	559/972	57.6	NR	Case detection: Moderate Data collection methods: Strong
				1-4 year	48/144	33.3	NR
				5-9 year	117/209	55.9	NR
				10-14 year	66/111	NR	NR
				15-19 year	144/235	NR	NR
				≥20 year	181/272	66.5	NR

Reference	Design	Outcome description	Region and study period	Outcomes stratified by age	Outcome			Quality score and comment
Reference	Design	Outcome description	Region and study period	Outcomes stratified by age	n/N	Outcome	95% CI	Quality score and comment
Tanaka, 2000 (18)	Cross-sectional study	Seroprevalence (N; %)	Caracas Period NR	1-40 year	NR	55	NR	Case detection: Can't tell Data collection methods: Strong
				1-5 year	NR	27.3	NR
				6-10 year	NR	54	NR
				11-15 year	NR	62	NR
				16-20 year	NR	72	NR
				21-30 year	NR	66	NR
				31-40 year	NR	89	NR
Ministerio del Poder Popular para la Salud, 2016 – GL (73)	Epidemiological report	Incidence rate per 100,000 inhabitants	Nationwide 2016	All ages	4305/NR	13.88	NR

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